2023

Editorial: Complement Deficiency States, Disease Susceptibility, and Infection Risk in Systemic Lupus Erythematosus

V. Michael Holers

2026

Review: Neuroimaging in Neuropsychiatric Systemic Lupus Erythematosus

Wilmer L. Sibbitt, Jr., Randy R. Sibbitt, and William M. Brooks

2039

Low Secretion of Tumor Necrosis Factor [alpha], But No Other Th1 or Th2 Cytokines, by Peripheral Blood Mononuclear Cells Correlates with Chronicity in Reactive Arthritis

Jurgen Braun, Zhinan Yin, Inge Spiller, Stefanie Siegert, Martin Rudwaleit, Lanzhen Liu, Andreas Radbruch, and Joachim Sieper

This study shows that low TNF[alpha] production is associated with a worse and more chronic disease course in patients with reactive arthritis, and that this is partly related to HLA-B27. Furthermore, clear differences in the cytokine profile of patients with reactive arthritis and rheumatoid arthritis were found. These findings might influence future treatment strategies.

2045

Modulation of Peripheral Blood Mononuclear Cell Activation Status During Salmonella-Triggered Reactive Arthritis

Juha Kirveskari, Qiushui He, Tim Holmstrom, Marjatta Leirisalo-Repo, Maarit Wuorela, Jussi Mertsola, and Kaisa Granfors

This study provides evidence that activation of PBMC is extensively modulated during ReA, up-regulated during the acute phase of the disease, and down-regulated during amelioration of ReA. These findings suggest that PBMC activation status might be important in the outcome of ReA and reveal new insight into immunosuppressive treatment.

2055

V2 Regions of 16S Ribosomal RNA Used as a Molecular Marker for the Species Identification of Streptococci in Peripheral Blood and Synovial Fluid from Patients with Psoriatic Arthritis

Qingmin Wang, Frank B. Vasey, J. Paul Mahfood, Joanne Valeriano, Keith S. Kanik, Burt E. Anderson, and Paul H. Bridgeford

PsA is a distinct rheumatic disorder characterized by inflammatory articular involvement in 7-10% of patients affected with psoriasis. The arthropathy associated with psoriasis combines features of both rheumatoid arthritis and the seronegative spondylarthropathies. This study demonstrated the presence of group A streptococcal rRNA in peripheral blood and synovial fluid of patients with PsA. Although there is no uniform agreement of classification, results of clinical, epidemiologic, genetic, and radiologic studies suggest that psoriatic arthritis is a separate disease entity that is distinct from other inflammatory arthritides.

2060

A New Spin on an Old Model: In Vivo Evaluation of Disease Progression by Magnetic Resonance Imaging with Respect to Standard Inflammatory Parameters and Histopathology in the Adjuvant Arthritic Rat

Peer B. Jacobson, Sheryl J. Morgan, Denise M. Wilcox, Phong Nguyen, Christine A. Ratajczak, Richard P. Carlson, Richard R. Harris, and Merrill Nuss

This study demonstrates the utility of MRI as a noninvasive research tool to uniquely characterize soft tissue and bony changes associated with rat adjuvant-induced arthritis, complementing more classic inflammatory parameters and histologic evaluation techniques. The integrated information obtained from these analytic approaches demonstrates the relevance of adjuvant arthritis for studying pathologic changes that are characteristic of human rheumatoid arthritis.

2074

Cleavage of Aggrecan at the Asn341-Phe342 Site Coincides with the Initiation of Collagen Damage in Murine Antigen-Induced Arthritis: A Pivotal Role for Stromelysin 1 in Matrix Metalloproteinase Activity

Joyce van Meurs, Peter van Lent, Reinout Stoop, Astrid Holthuysen, Irwin Singer, Ellen Bayne, John Mudgett, Robin Poole, Clark Billinghurst, Peter van der Kraan, Pieter Buma, and Wim van den Berg

The destruction of articular cartilage during arthritis is due to proteolytic cleavage of the extracellular matrix. The role of MMPs in cartilage degradation is still a matter of debate. This study shows that appearance of VDIPEN neoepitopes in aggrecan coincides with initiation of collagen damage. Furthermore, this study emphasizes that stromelysin 1 is essential in the induction of MMP-specific cleavage of both aggrecan and collagen. It suggests that stromelysin 1 is not a dominant enzyme in proteoglycan breakdown, but it might be crucial in the initiation of collagen damage.

2085

Enhanced T Cell Proliferative Response to Type II Collagen and Synthetic Peptide CII (255-274) in Patients with Rheumatoid Arthritis

Ho-Youn Kim, Wan-Uk Kim, Mi-La Cho, Suk Kyeong Lee, Jeehee Youn, Sung-Il Kim, Wan-Hee Yoo, Jae-Ho Park, Jun-Ki Min, Sang-Heon Lee, Sung-Hwan Park, and Chul-Soo Cho

In this study, T cell responses to CII were enhanced in the majority of patients with RA, and this correlated inversely with humoral responses, especially in the early stage of RA. Furthermore, synthetic immunodominant peptide CII (255-274), as well as native CII, could be recognized as immunogenic antigens by T cells, particularly cells from the joints. These data suggest that autoreactive T cells responding to CII play an important role in the pathogenesis of human RA, and therefore, active suppression of autoreactive T cells using synthetic peptide CII (255-274) could be useful to induce tolerance in RA.

2094

Cartilage Protection by Nitric Oxide Synthase Inhibitors After Intraarticular Injection of Interleukin-1[beta] in Rats

Nathalie Presle, Christine Cipolletta, Jean-Yves Jouzeau, Amr Abid, Patrick Netter, and Bernard Terlain

Blocking increased production of NO is a potential strategy for preventing or delaying cartilage injury. This study showed that a single intraarticular injection of interleukin-1[beta] in rats induced a time-dependent increase in NO release in synovial fluid, accompanied by a delayed inhibition of proteoglycan synthesis. Among NOS inhibitors studied, only amino acid derivatives were shown to be effective in both suppressing NO production and recovering cartilage anabolism. This chondroprotection can be achieved by local administraion of NOS inhibitors and is improved by systemic and sustained delivery. These findings confirm the therapeutic usefulness of NOS inhibitors in cartilage destruction.

2103

Estrogen Replacement Therapy Modulation of the Insulin-Like Growth Factor System in Monkey Knee Joints

Janet K. Fernihough, Renee S. Richmond, Cathy S. Carlson, Tom Cherpes, Jeffrey M. P. Holly, and Richard F. Loeser

This study provides evidence that estrogen replacement therapy can increase the synovial fluid levels of certain components of the IGF system. Regulation of the IGF system in joint tissues by estrogen represents a potential mechanism by which estrogen replacement could protect against the development or progression of osteoarthritis in postmenopausal women.

2112

Abnormal Regulation of Urokinase Plasminogen Activator by Insulin-Like Growth Factor 1 in Human Osteoarthritic Subchondral Osteoblasts

George Hilal, Johanne Martel-Pelletier, Jean-Pierre Pelletier, Nicolas Duval, and Daniel Lajeunesse

This study is the first to show an abnormal regulation of urokinase plasminogen activator by insulin-like growth factor 1 in subchondral osteoblasts of humans with OA, a situation that could contribute to subchondral bone sclerosis. The data suggest that abnormal osteoblast metabolism may have an important role in OA and could therefore contribute to changing our perception of the pathogenesis of the disease.

2123

Nitric Oxide Production and Apoptosis in Cells of the Meniscus During Experimental Osteoarthritis

Sanshiro Hashimoto, Kenji Takahashi, Robert L. Ochs, Richard D. Coutts, David Amiel, and Martin Lotz

Menisci are required for normal biomechanical function of the knee joint. Meniscus lesions can lead to the development of OA, and the destructive processes that are present in both the inflammatory arthropathies and OA affect the menisci. The present study of experimental OA induced by anterior cruciate ligament transection in rabbits demonstrates that meniscus cells undergo apoptosis and produce high levels of NO. These results suggest that inhibitors of NO production and agents that promote cell survival may be of value in limiting meniscus destruction.

2132

An IgG Antiprothrombin Antibody Enhances Prothrombin Binding to Damaged Endothelial Cells and Shortens Plasma Coagulation Times

Yan Zhao, Robert Rumold, Min Zhu, Daobin Zhou, Alaa E. Ahmed, Dzung T. Le, Bevra H. Hahn, Virgil L. Woods, Jr., and Pojen P. Chen

The roles of antiphospholipid antibodies in antiphospholipid syndrome are unclear. This study shows that a patient-derived monoclonal antiprothrombin antibody enhances the binding of prothrombin to damaged EC and shortens the EC-based plasma coagulation times. These findings suggest that similar antiprothrombin antibodies may promote coagulation in areas of damaged EC in patients and thus contribute to thrombosis.

2139

Exclusion of the Gene for Human Cartilage Intermediate Layer Protein in Currently Mapped Calcium Pyrophosphate Dihydrate Deposition Syndromes

R. Catrinel Marinescu, Kristin Nyce, Lourdes Serrano de la Pena, Joan Overhauser, and Charlene J. Williams

CPPD deposition disease may occur as a familial condition that is inherited in an autosomal dominant manner. The disorder in several affected families has been chromosomally mapped to loci on chromosomes 8q and 5p. This study mapped the gene for human cartilage intermediate layer protein (CILP), which contains, at its 3` end, a sequence homologous to the porcine enzyme nucleoside triphosphate pyrophosphohydrolase, to chromosome 15q21. The results exclude involvement of the CILP gene in the CPPD disease syndromes that have been chromosomally mapped to date.

2145

Mannose-Binding Lectin Polymorphisms and Susceptibility to Infection in Systemic Lupus Erythematosus

Peter Garred, Hans O. Madsen, Poul Halberg, J<slasho>rgen Petersen, Gitte Kronborg, Arne Svejgaard, Vagn Andersen, and S<slasho>ren Jacobsen

This study demonstrates that patients with SLE who are deficient in mannose-binding lectin have a very high risk of acquiring complicating infections, and that this risk is not related to treatment. The patients lacking mannose-binding lectin were especially prone to developing pneumonia. Moreover, the findings confirm that mannose-binding lectin deficiency is a minor susceptibility factor for acquiring SLE.

2153

The Prosorba Column for Treatment of Refractory Rheumatoid Arthritis: A Randomized, Double-Blind, Sham-Controlled Trial

David T. Felson, Michael P. LaValley, Andrew R. Baldassare, Joel A. Block, Jacques R. Caldwell, Grant W. Cannon, Chad Deal, Stephen Evans, Roy Fleischmann, R. Michael Gendreau, E. Robert Harris, Eric L. Matteson, Sanford H. Roth, H. Ralph Schumacher, Michael H. Weisman, and Daniel E. Furst

The Prosorba column is a medical device, used in conjunction with plasmapheresis, that contains highly purified staphylococcal protein A bound to a silica matrix. In this randomized, sham apheresis-controlled clinical trial of Prosorba column treatments in patients with RA that was refractory to other treatments, those patients who were randomized to receive treatment with the column were more likely to experience improvement than were sham-treated patients.

2160

Comparison of Two Schedules for Administering Oral Low-Dose Methotrexate (Weekly Versus Every-Other-Week) in Patients with Rheumatoid Arthritis in Remission: A Twenty-Four-Week, Single-Blind, Randomized Study

Magdalena Luis, Cesar Pacheco-Tena, Jorge Cazarin-Barrientos, Leticia Lino-Perez, Maria Victoria Goycochea, Janitzia Vazquez-Mellado, and Ruben Burgos-Vargas

This study demonstrates similar efficacy of every-other-week administration and conventional weekly administration of MTX in maintaining MTX-induced remission in RA patients (defined by the American College of Rheumatology RA remission criteria). Well-controlled disease (according to rigorous adherence to remission criteria), short disease duration, and early treatment with MTX are major factors in the success of this form of therapy.

2166

Treatment with Monoclonal Anti-Tumor Necrosis Factor [alpha] Antibody Results in an Accumulation of Th1 CD4+ T Cells in the Peripheral Blood of Patients with Rheumatoid Arthritis

Madelon M. Maurice, Wiebo L. van der Graaff, Angela Leow, Ferdinand C. Breedveld, Rene A. W. van Lier, and Cornelis L. Verweij

The use of TNF[alpha]-reducing agents could be an important element in the future treatment of RA. This study provides new insights into the nature of the observed lymphocytosis following the use of an anti-TNF[alpha] monoclonal antibody in RA patients and suggests an additional mode of action of the therapy.

2174

The Influence of HLA-DRB1 Alleles and Rheumatoid Factor on Disease Outcome in an Inception Cohort of Patients with Early Inflammatory Arthritis

Beverley Harrison, Wendy Thomson, Deborah Symmons, Bill Ollier, Nicola Wiles, Tony Payton, Elizabeth Barrett, and Alan Silman

This large, prospective, population-based study attempted to determine the exact role of HLA-DRB1 alleles in short-term outcome in early rheumatoid arthritis. Among patients in this study who were newly presenting with inflammatory polyarthritis, those with shared epitope (SE)-bearing HLA-DRB1 alleles were approximately twice as likely to develop radiologic erosions as those who were SE negative. However, HLA genes did not influence outcome in patients who were positive for RF, and offered little additional predictive power over that obtained from RF status alone.

2184

Persistence of Mild, Early Inflammatory Arthritis: The Importance of Disease Duration, Rheumatoid Factor, and the Shared Epitope

Michael Green, Helena Marzo-Ortega, Dennis McGonagle, Richard Wakefield, Susanna Proudman, Philip Conaghan, Jimmy Gooi, and Paul Emery

The early treatment of rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs (DMARD) is now commonplace. However, there is concern that occasionally this approach exposes patients with self-limiting disease to toxic DMARD. In this study, a group of patients with mild, early inflammatory arthritis received a single dose of corticosteroids and was followed up. It is clear that certain patients who fulfill the American College of Rheumatology RA classification criteria at presentation, especially those with <12 weeks of disease, have an excellent prognosis. This study provides the first evidence for a possible approach to management of such patients with early disease.

2189

Objective and Subjective Sleep Disturbances in Patients with Systemic Lupus Erythematosus

Matilde Valencia-Flores, Montserrat Resendiz, Violeta A. Castano, Victoria Santiago, Rosa M. Campos, Sayonara Sandino, Xavier Valencia, Jorge Alcocer, Guillermo Garcia Ramos, and Donald L. Bliwise

SLE patients often experience disturbed sleep. This study used polysomnography to examine nocturnal sleep in SLE patients and normal control subjects of similar age. The results suggest that there is a high frequency of primary sleep disorders in SLE patients.

2194

Poly(ADP-Ribose) Polymerase Alleles in French Caucasians are Associated Neither with Lupus Nor with Primary Antiphospholipid Syndrome

O. Delrieu, M. Michel, C. Frances, O. Meyer, C. Michel, F. Wittke, I. Crassard, J. F. Bach, E. Tournier-Lasserve, and J. C. Piette for the GRAID Research Group

It has recently been suggested that poly(ADP-ribose) polymerase (PARP) gene polymorphism is involved in susceptibility to systemic lupus erythematosus (SLE) in American SLE patients. This association study was conducted to assess the putative involvement of PARP alleles in French Caucasian patients with either SLE or primary antiphospholipid syndrome (APS), a condition closely related to SLE. It was found that PARP gene polymorphism does not influence SLE or primary APS susceptibility in French Caucasians.

2198

Detection of Bacterial DNA in Serial Synovial Samples Obtained During Antibiotic Treatment from Patients with Septic Arthritis

Ineke M. van der Heijden, Bert Wilbrink, Arianne E. M. Vije, Leo M. Schouls, Ferdinand C. Breedveld, and Paul P. Tak

The management of septic arthritis could benefit from sensitive tests that detect the persistence of microorganisms in the joint. This report describes the feasibility of monitoring the presence of bacterial DNA in synovial samples from septic arthritis patients during antibiotic treatment. The use of polymerase chain reaction with universal primers allowed the identification of bacterial DNA from various species in trace levels in infected human synovial samples.

2204

Extrahepatic Manifestations of Chronic Hepatitis C

Patrice Cacoub, Thierry Poynard, Pascale Ghillani, Frederic Charlotte, Martine Olivi, Jean Charles Piette, and Pierre Opolon, for the MULTIVIRC Group

In a prospective study, data from 1,614 patients with chronic HCV infection, coming from a single monocenter French cohort, were analyzed to assess the prevalence of clinical and biologic extrahepatic manifestations. Clinical extrahepatic manifestations were frequently observed and involved primarily the joints, muscles, and skin. The most frequent immunologic abnormalities included mixed cryoglobulins, antinuclear antibodies, and anti-smooth muscle antibodies. By univariate and multivariate analyses, the most frequent risk factors for the presence of clinical and biologic extrahepatic manifestations were advanced age, female sex, and extensive liver fibrosis.

2213

Development of Validated Disease Activity and Damage Indices for the Juvenile Idiopathic Inflammatory Myopathies. II. The Childhood Myositis Assessment Scale (CMAS): A Quantitative Tool for the Evaluation of Muscle Function

Daniel J. Lovell, Carol B. Lindsley, Robert M. Rennebohm, Susan H. Ballinger, Suzanne L. Bowyer, Edward H. Giannini, Jeanne E. Hicks, Joseph E. Levinson, Richard Mier, Lauren M. Pachman, Murray H. Passo, Maria D. Perez, Ann M. Reed, Kenneth N. Schikler, Michaele Smith, Lawrence S. Zemel, and Lisa G. Rider, in Cooperation with the Juvenile Dermatomyositis Disease Activity Collaborative Study Group

The Childhood Myositis Assessment Scale is an observational tool to evaluate in a quantitative manner muscle function in the areas of strength and endurance in children with idiopathic inflammatory myopathies. This tool was designed and has been used in routine clinical assessment of patients. The demonstration of excellent intra- and interobserver validity supports the use of this tool in clinical trials.

2220

Toward a Multidimensional Health Assessment Questionnaire (MDHAQ): Assessment of Advanced Activities of Daily Living and Psychological Status in the Patient-Friendly Health Assessment Questionnaire Format

Theodore Pincus, Christopher Swearingen, and Frederick Wolfe

The HAQ and its derivatives are widely used in rheumatology to depict, monitor, and predict clinical status. However, there remain certain limitations, including ``floor effects,'' in which patients report normal scores although they experience meaningful functional limitations, and the absence of psychological data important in the course and outcomes of rheumatic diseases. This report describes 2 short scales that have been developed to overcome these limitations within the widely accepted, ``patient-friendly'' HAQ format, and these questionnaires are easily completed by patients in routine clinical care.

2231

Sonography and Magnetic Resonance Imaging Equivalent for the Assessment of Full-Thickness Rotator Cuff Tears

Wijnand A. A. Swen, Johannes W. G. Jacobs, Paul R. Algra, Radu A. Manoliu, Jan Rijkmans, Willem J. Willems, and Johannes W. J. Bijlsma

In this study, SG and MRI prove to be equivalent imaging techniques for the detection of full-thickness rotator cuff tears. SG has the advantage over MRI in that it is less expensive and can be performed by the clinician.

2238

Error in Letter by Bresnihan et al (Arthritis Rheum, August 1999)

2239

Clinical and Experimental Evidence for Persistent Yersinia Infection in Reactive Arthritis

J. S . Hill Gaston, Charles Cox, and Kaisa Granfors

2243

Distinguishing Primary Angiitis of the Central Nervous System from Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy: The Importance of Family History

Eric E. Williamson, Felix E. Chukwudelunzu, James F. Meschia, Robert J. Witte, Dennis W. Dickson, and Marc D. Cohen

2249

Shrinking Lung in Primary Sjogren's Syndrome

Antonio Tavoni, Claudio Vitali, Giovanna Cirigliano, Sabrina Frigelli, Giulia Stampacchia, and Stefano Bombardieri

2250

Antiphospholipid Antibodies in Patients with Wegener's Granulomatosis and Polyarteritis Nodosa

Karen E. Hansen, Karen D. Moore, Thomas L. Ortel, and Nancy B. Allen

2252

Long-Term Followup of Naproxen-Induced Pseudoporphyria in Juvenile Rheumatoid Arthritis

S. Mehta and B. Lang

2255

Leukocytapheresis and Rheumatoid Arthritis: Comment on the Article by Hidaka et al

Daniel J. Wallace

2255

Reply

Toshihiko Hidaka, Kimihiro Suzuki, and Fumitaka Ohsuzu

2256

Association Between the Inflammatory Response and the Risk of Developing Irreversible Cranial Ischemic Complications: Comment on the Article by Cid et al and the Letter by Nesher and Sonnenblick

Eric Liozon, Marie Odile Jauberteau, Veronique Loustaud, and Elisabeth Vidal

2257

Reply

Maria C. Cid, Carme Font, Alejandro de la Sierra, Blanca Coll-Vinent, Alfons Lopez-Soto, Alvaro Urbano-Marquez, and Josep M. Grau

2258

Reply

Gideon Nesher

2258

Giant Cell Arteritis Disease Patterns: Comment on the Article by Brack et al

Alan B. Marks

2258

Reply

Cornelia M. Weyand and Jorg J. Goronzy

2259

Ovarian Failure with Thalidomide Treatment in Complex Aphthosis: Comment on the Concise Communication by Ordi et al

A. Gompel, C. Frances, J. C. Piette, A. S. Blanc, F. Cordoliani, and A.-M. Piette

2260

Reply

Jose Ordi, Fina Cortes, Eva Balada, Montse Mauri, and Miguel Vilardell

23A

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